ProviderConnect Claims. March 2018

Transcription

1 ProviderConnect Claims March 2018

2 Agenda ProviderConnect Advantages Claims Process Improvement How to Access ProviderConnect Direct Claim Submission Batch Claim Submission Claim Search Correcting a Claim EAP Case Activity Form Submission Viewing Provider Summary Vouchers 2

3 ProviderConnect Advantages 3

4 Services Verify member benefits and eligibility View and print forms Request and view authorizations Download and print authorization letters Submit claims and view status Access Provider Summary Vouchers (PSV) Request payment for EAP services Submit EAP case activity forms (CAF) Submit updates to provider demographic information Submit credentialing applications Submit customer service inquiries Access ProviderConnect message center Disclaimer: Please note that ProviderConnect may look different and have different functionalities based on individual contract needs, therefore some functions may not be available or may look different for your specific contract. 4

5 Benefits Free and secure online application, available 24/7 Reduces the need to call for routine information Integrates with practice management software Decreases labor expenses, paper files, and postage Efficient processing allows for quicker payment Less risk of human error or mishandling Mobile device friendly Mac and Windows compatible INCREASED CONVENIENCE, DECREASED ADMINISTRATIVE PROCESSES 5

6 Claims Process Improvement Program 6

7 Claims Process Improvement (CPI) Project Mailroom Project: Transition to a centralized shared-service process to improve paper claims intake Mailing addresses changed in 2017 Incomplete or incorrect claims will be rejected EDI/Data Exchange: Implement a single gateway for front-end claims intake for all Beacon submitters to improve intake and processing of electronically submitted batch claims New companion guides will be released for 837 and 277CA files Payment Integrity and Claims Analysis: Analyze claims to identify payment errors Documentation requests to verify submissions and payment accuracy Claim adjustments will occur if overpayment is identified 7

8 E-Commerce Providers in the Beacon Health Options network are expected to electronically conduct all routine transactions, including: Submission of claims Submission of authorization requests Verification of eligibility inquiries Submission of credentialing applications Updating of provider information Electronic fund transfer through PaySpan Health 8

9 How to Access ProviderConnect 9

10 How to Access ProviderConnect 10

11 How to Access ProviderConnect Click on ProviderConnect on the right side of the screen and choose the appropriate portal. 11

12 Tips for Claim Submission Success When submitting any claim, be sure to complete all required fields Providers: Tips for completing the CMS-1500 or UB04 located under Administrative Forms EAP: Be mindful of case opening questions for each submission and case closing questions at final billing Direct claim submission: Required fields designated with an asterisk (*) Batch claim submission: Follow the Implementation and Companion Guides located on the ProviderConnect resource page 12

13 Direct Claim Submission 13

14 Direct Claim Submission 14

15 Direct Claim Submission 15

16 Direct Claim Submission 16

17 Direct Claim Submission 17

18 Direct Claim Submission - COB 18

19 Direct Claim Submission 19

20 Direct Claim Submission 20

21 Summary Page 21

22 Direct Claim Submission Provides ability to enter a claim directly into ProviderConnect portal without using special software Expedites processing of the claim and payment Available for professional services only, not higher levels of care Recommended for providers submitting a lower volume of outpatient claims 22

23 Batch Claim Submission 23

24 Batch Claim Submission 24

25 Batch Claim Submission 25

26 Batch Claim Submission 26

27 Batch Claim Submission 27

28 Batch Claim Submission 28

29 Batch Claim Submission 29

30 Batch Claim Submission Allows you to upload HIPAA 5010 compliant files directly to Beacon Expedites processing of the claim and payment Available for all levels of care Recommended for facilities and providers submitting a higher volume of claims Payer ID FHC &Affiliates Clearinghouses may provide their own five digit payer ID for Beacon Health Options Contact your clearinghouse to see what payer ID is needed 30

31 EDI Claims Link for Windows (ECLW) Free Beacon Health Options software that submits HIPAA 5010 compliant files Used only for claims submitted directly to Beacon Health Options Available for download under ECLW on our ProviderConnect page Only available for Windows platform 31

32 Claim Search 32

33 Review a Claim 33

34 Search Claims 34

35 Search Claims by Member 35

36 Search Claims by Member 36

37 Search Claims by Member 37

38 View Member Claims 38

39 Claims Summary 39

40 Service Line Detail 40

41 Correcting a Claim 41

42 Reasons to Correct a Claim Change Claim Data Incorrect diagnosis code, service date, etc. Incorrect service address Voiding one line of the claim Resubmit Previously Denied Charge Member eligibility was updated Authorization was updated Void Entire Claim Claim was entered for incorrect member Entire claim was incorrect and a new claim is needed or requested 42

43 Change/Reprocess Claim 43

44 Disclaimer 44

45 Type of Adjustment 45

46 Select Service Address 46

47 Member Search 47

48 Coordination of Benefits 48

49 Service Line Entry 49

50 Attaching an EOB 50

51 Summary Page 51

52 EAP Case Activity Form Submission 52

53 EAP Case Activity Form Submission 53

54 Authorization Search 54

55 Enter EAP CAF 55

56 Online CAF Key Points Select a Billing Type Complete all case opening questions for both interim and final billing type If Final was selected for billing type, complete all case closing questions 56

57 Summary Page 57

58 Viewing Provider Summary Vouchers 58

59 Provider Summary Vouchers 59

60 Search by Provider 60

61 Search by Check 61

62 Provider Summary Voucher Results 62

63 PaySpan Health: Electronic Funds Transfer (EFT) Multiple registration options: Through PaySpan s website by clicking the link in ProviderConnect or visiting PaySpanHealth.com Call PaySpan at Have registration code and PIN from the payment stub of a paper check handy Note: EFT is location specific, so if you update or add an address, you will have to contact PaySpan to add it to your file Until successful registration with PaySpan is complete, physical checks will continue be generated 63

64 Additional Training Options 64

65 Helpful Resources On the provider homepage choose ProviderConnect Scroll down to find: ProviderConnect Demo Guides Forms Compliance Resources EDI Resources How-to video tutorials Webinars and archives 65

66 Contact Information Website and EDI PaySpan Provider Relations Beacon Health Strategies eservices Phone: Electronic Data Interchange Phone: PaySpan Registration Provider Support Monday through Friday, 8 a.m. 8 p.m. ET Phone: providersupport@payspanhealth.com Provider Relations Phone: Provider.Relations@beaconhealthoptions.com Beacon Health Options (formerly ValueOptions) EDI Helpdesk Monday through Friday, 8 a.m.-6 p.m. ET Phone: e-supportservices@beaconhealthoptions.com Unable to locate your registration code? corporatefinance@beaconhealthoptions.com Reply will be received within three business days National Provider Services Line Monday through Friday, 8 a.m.-8 p.m. ET Phone: Regional Provider Relations Team 66

67 Thank you 67